Caffeine has become an ubiquitous drug. Used originally in most cultures for ceremony or some daily stimulation, it has become a regular, overused energy stimulant in the Western world, with the United States leading in coffee and caffeine use.

Coffee, brewed from the ground-up coffee bean (Coffea arabica), is the major vehicle for caffeine consumption. In this country, more than a half billion cups are drunk daily, with most consumers drinking two or more cups, and more than ten pounds of coffee per person are consumed yearly. This food/drug mixture, often along with sugar and/or milk, is one of the most freely marketed substances in the world.

There are several basic areas of concern about this substance. I believe that a major one, possibly even more important than the caffeine itself, is the toxic chemicals used in the many stages of growing and marketing coffee. The easily rancified oils and the irritating acids contained in the beans offer further hazards. People trying to cut down by drinking decaf could even be exposed to dangerous chemicals unless they are drinking coffee prepared by the water process or Swiss process, which uses steam distillation to remove the caffeine. Otherwise, agents such as TCE (trichlorethylene) or methylene chloride used in the chemical processing may be contained as residues in the decaf coffee. More coffee-drinking concerns have arisen over the last decades as pesticide use and chemical processing have generally increased, though fortunately our coffee consumption has lessened over the last 40 years. In 1946, at the peak of use, yearly consumption was 20 pounds per person; since most children and some adults were not consuming any, many people were consuming a lot more than the 1,000-cup-a-year average. In 1979, estimated consumption was down to around 9 pounds per year, or about two cups per day per person. It has gone up slightly since then, here and in many other countries of the world, where it is also consumed in large quantities.

Another problem is caffeine's widespread use in so many products, such as soft drinks and many over-the-counter (OTC) drugs. All products containing caffeine should carry a warning saying something like, "Caffeine can be hazardous to your health. Regular use may be addicting and injurious." The problem here is less with the drug itself and more with the amounts consumed and the constant stimulation on which people depend many times daily. One big area of concern here is with children and teenagers, who may consume large amounts of caffeine in soft drinks. Cola naturally contains caffeine, yet many soft drinks have even more added. The caffeine creates an addiction to the drink.

Another concern is that caffeine addiction often occurs along with other substance abuses, nicotine and sugar most commonly. Caffeine, like sugar, overstimulates the adrenals and then weakens them with persistent or chronic use. First, sugar stimulates and weakens the adrenals, which creates fatigue. Then we use caffeine to keep us aware and awake, further depleting our adrenals, to which many respond by drinking more caffeine with sugar. In addition, people who overuse caffeine tend to need more tranquilizers and sleeping pills to help them relax or sleep.

Caffeine can be a lifetime drug for many. We begin with hot chocolate or chocolate bars, which contain some caffeine, move into colas or other soft drinks with caffeine, and then add coffee and tea. Many adults use caffeine daily, but this is slowly changing with education and experience revealing the long-range problems resulting from caffeine abuse.

Caffeine, one of the class of methylxanthine chemicals/drugs, is present in coffee and many other drinks and products. Another of the xanthines, theophylline, is found in black teas; it is also commonly used in medicine to aid in breathing. Theobromine, the third xanthine derivative, is found in cocoa. Methylxanthines are found in many other plants, including the kola nut originally used to make cola drinks.

Physiologically, caffeine is a central nervous system (CNS) stimulant. A dosage of 50-100 mg., the amount in one cup of coffee, will produce an apparent temporary increase in mental clarity and energy level while reducing drowsiness. For many users, it specifically improves muscular-coordinated work activity, such as typing. Through its CNS stimulation, caffeine increases brain activity, but it also stimulates the cardiovascular system, raising blood pressure and heart rate. It generally speeds up our body, increasing the basal metabolic rate (BMR), which can help burn more calories. Initially, caffeine may lower blood sugar, leading to increased hunger or craving for sweets. After the adrenal stimulation, the blood sugar rises again. Caffeine also increases the respiratory rate, and for people with tight airways, it opens the breathing passages, as do the other xanthine drugs. Caffeine is also a diuretic and a mild laxative, an effect that many coffee drinkers appreciate.

The amount needed to produce the wake-up and stimulation effect increases with regular use, as is typical of addictive drugs. Larger and more frequent doses are needed for the same effect, and symptoms can develop if we do not get our "fix." Eventually, we need the drug to function; without it, fatigue and drowsiness occur. So caffeine is a natural stimulant with both physical and psychological addiction potential and with withdrawal symptoms similar to the symptoms of its abuse.

A nutritional concern of most caffeine products is that they do not contain any of the nutrients (coffee and tea have a little manganese and copper) needed to support the increased activity that they cause. Also, the diuretic effect of caffeine leads to the urinary loss of many nutrients.

There are many possible symptoms and signs of caffeine intoxication and abuse. People who are already overstimulated, busy types (adrenal or fiery types) do not necessarily like the effects of caffeine. I have never been inclined to drink coffee because of both the taste and the effects, yet I understand that many people thoroughly enjoy the experience. The key to its use is moderation and avoiding addiction (even daily use can be considered as addiction). Allergy-type addiction is also fairly common, especially with coffee, but also with tea, chocolate, and cola. With allergy, withdrawal from the substance may lead to even worse symptoms.

Overall, addiction to caffeine is not as bad as addiction to most other drugs, but it is a problem for many. Completely stopping its use or tapering it off over time before stopping may produce several symptoms. Usually, the slower the tapering, the easier the withdrawal. After withdrawal and detox from caffeine, it is possible that it can still be used in moderation, but for many people, it can easily become a habit and addiction again. We cannot really know the severity of our addiction until we get off caffeine.

Signs and Symptoms of Caffeine Intoxication or Abuse

nervousness

headache

increased heart rate

anxiety

upset stomach

irregular heartbeat

irritability

GI irritation

elevated blood pressure

agitation

heartburn

increased cholesterol

tremors

diarrhea

nutritional deficiencies

insomnia

fatigue

poor concentration

depression

dizziness

bed wetting

Caffeine Withdrawal Symptoms

headache

constipation

runny nose

craving

anxiety

nausea

irritability

nervousness

vomiting

insomnia

shakiness

cramps

fatigue

dizziness

ringing in the ears

depression

drowsiness

feeling hot and cold

apathy

inability to concentrate

tachycardia

The most common withdrawal symptom is a throbbing and/or pressure headache, usually located at the temples but occasionally at the back of the head or around the eyes. A vague muscular headache often follows. Of course, caffeine cures the symptom; but this is not the answer. Dietary guidelines and supplements may help with this and other withdrawal problems.

Let us now look at the wide range of uses of caffeine in the food and drug industries. Caffeine and caffeinelike xanthines are contained in coffee, many teas, cola, and chocolate. Of the teas, all "black" teas or common teas contain theophylline and theobromine, as do some "green" teas. Both contain less caffeine than coffee. These teas and coffee also contain tannic acid, which is a mild irritant to the gastrointestinal mucosa, and may further bind and reduce absorption of minerals, such as manganese, zinc, and copper. Most herbs do not contain caffeine, although maté and guarana are fairly high in caffeine. The kola nut and the cocoa bean also contain caffeine. All of these are natural products that have been used as stimulants throughout history; today, caffeine and its related stimulating xanthines are used in many artificial products, including soft drinks such as Coca-Cola, Pepsi Cola, Mountain Dew, Dr. Pepper, and Jolt, plus many chocolate bars. (Some of the soft drink companies are now making caffeine-free drinks.)

Caffeine-Containing Food Products

yerba maté

guarana root

kola nut

cocoa/chocolate

some soft drinks

tea

coffee

Both extracted and synthesized caffeine may be added to other products. Many common pharmaceutical preparations contain caffeine for its stimulating effects to counteract sedating antihistamines or for its cerebral vasodilating effects to relieve vascular headaches. Cafergot is a prescription drug containing caffeine and is used for migraines; thus, caffeine can help reduce headaches or cause them, which is more common.

Elson M. Haas, MD is founder & Director of the Preventive Medical Center of Marin (since 1984), an Integrated Health Care Facility in San Rafael, CA and author of many books on Health and Nutrition, including ...more

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